MEDICARE: TONIA BLACKWELL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5017182	NC

General Provider Information

NPI Number	:	1457045197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA BLACKWELL FNP

Provider Business Mailing Address
First Line	:	1424 S JK POWELL BLVD STE E
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-9145
Country	:	US
Telephone Number	:	910-207-6577
Fax Number	:	910-207-6511

Provider Business Practice Location Address
First Line	:	1424 S JK POWELL BLVD STE E
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-9145
Country	:	US
Telephone Number	:	910-207-6577
Fax Number	:	910-207-6511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	03/10/2026

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